Only two countries on earth allow drug companies to advertise prescription medications directly to the public: the United States and New Zealand. New Zealand has 5 million people and doesn’t own the world’s largest pharmaceutical market. We have 335 million patients, a drug industry that spent nearly $13.8 billion on advertising and promotion in 2023 alone, and a regulatory system that requires a physician’s signature on the product while letting Madison Avenue write the demand.

The core absurdity isn’t hard to find. Only physicians can prescribe. Yet pharmaceutical companies spend billions telling patients what to request before they ever sit down with a doctor. The FDA permits it. Federal courts treat it as protected commercial speech. Washington has decided that advertising qualifies as patient education, which says something interesting about how we view both patients and education.

The money involved clarifies everyone’s motives. Between 1997 and 2016, pharma marketing to healthcare professionals climbed from $15.6 billion to $20.3 billion, while direct-to-consumer spending rose from $2.1 billion to $9.6 billion over the same stretch. The television spots are only part of the picture. The bigger fight has always been for the person in the white coat.

Purdue Pharma is the industry’s most damning case study. Its sales force told physicians that OxyContin carried a low addiction risk—a false claim—and drove prescription volumes that created a dependent population........

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